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Monday, September 29, 2014

Fast Cash

Thanks to Corporate Greed, what should have been viewed as a worthwhile service, an important function of our jobs, has been relegated to the "you want fries with that?" suggestive sell.
Flu shots are important.
Getting one is important.
Waiting for 15 to 20 minutes to get one? Not so much...

I came up with a plan to deal with this scenario I had over the weekend.

Impatient Lady: I want a flu shot.
CP: Certainly. That will help me reach my quota. Please simply fill out this important, required questionnaire and I will process it for you.
IL: How long?
CP: About 20 minutes from start to stick.
IL: <throws paper and pen back> What? I want it now! Why do I have to wait? I'm going somewhere else.
CP: Okay, Veruca Salt. You do realize that the next closest pharmacy is a 20 minute drive, right? Plus you have to storm out of here, walk to your car, drive there, park there, go in there, wait in line there AND be told it'll be 20 minutes, right? Just making sure you have thoroughly thought through your hasty decision.
IL: <storms off>

It was then that I decided to revisit my Disney FastPass post from last year.
What if we offered "instant flu shots"? No waiting?
I don't mean a flu clinic where people still have to wait in line. (We used to have clinics where people would ask how long. I averaged 3 minutes per shot if all the paperwork was completed. Sorry, but the 20th person in line? He has an hour wait.)

I mean instant, shoot-em-up now flu shots.

IL: I want a flu shot.
CP: Certainly.
IL: How long?
CP: 20 minutes.
IL: What?! I can't wait that long. I have ice cream in the car with my baby who is on his way to the airport to fly to a dentist appointment for which he needs an antibiotic filled at another pharmacy one hour beforehand and the appointment is in 30 minutes.
CP: Wow. Well in that case, I have an alternative for you.
IL: What's that?
CP: Instant flu shot.
IL: Yes. Yes. I'll take it! How's it work?
CP: I walk with you into that little room over there, grab my syringe I pre filled this morning, and as I am helping you fill out the questionnaire, I am prepping you for the shot. I do all the hard work so you don't have to wait.
IL: I like this. Let's go.
CP: One catch.
IL: What's that?
CP: It costs $60.00
IL: What? All pharmacies are charging less than $30.00 for their flu shots.
CP: I know. But they are also making you wait...and wait...and wait...and fill out your own paperwork. Then they are billing your insurance. I am offering you a reasonable solution to your self-inflicted problem of poor time management. Your choice is simple: Wait 20 minutes or pay for the expedited, Platinum Club service. Maybe I'll even let you pick out your own BandAid...for free!

Friday, September 26, 2014

Phone Menus

Having to dial different pharmacies, insurance companies, prescriber offices, and takeout places can make one a so-called expert on phone menus. I like the ones that tell you "please listen to the message in its entirety: our options have changed".
When was the last time you updated that message? Your options haven't changed in years.
I think if you're going to change them, change them frequently. Also, make the options erratic and senseless. People will have to actually listen to them instead of getting menu fatigue. Change the options every week. If patients had to press 369 to request refills at your office, change it to 17 the next week and make 369 an automatic disconnect.
Will they call the pharmacy? Absolutely!
Will the ask us to call the office for them? Of course.

If you are from a prescriber's office, press 9999999999999999999999999999999999999.
If you wish to speak to a member of our pharmacy staff, press the square root of 4, cubed.
If you wish to call in a refill and have your rx#, press 1138.
If you wish to call in a refill and do NOT have your rx#, please hang up, go find your bottle, and call back.
If you are not sure what pharmacy you dialed, please press "end" on your phone and call back to listen to the greeting again.

A Letter to Corporate

Dear Corporate Pharmacy,

I would like to thank you for my gainful employment and the paychecks that come with it. It has been a great career so far and I have seen many changes that have improved our profession. Along with these positive changes, I have also witnessed the ruination of the profession I love. I lay the blame squarely at your feet, corporate rulers.
It is unfortunate that you seem so out of touch with what our profession represents. It is time you rethink your policies and procedures and hiring practices. It is time to take off your suits, walk into our stores, put on a lab coat, and do the job you wish to destroy; the job you think you know. While you are there, you can take a few pharmacists and technicians and move them into corporate offices so they can write the new P&P manuals. They can dictate how a pharmacy should work. More importantly, you need to STOP making policies and procedures and just let us do our jobs without interference.

Let me provide you an example.
Most pharmacies have two cash registers and many have a drive-thru. If I have one technician for the register and one to perform data entry, then no one is counting. If a line builds, people will wait and become irritated. They will complain. We at the store will get docked for poor customer service because we are not quick enough. However, we are working within the budget sent to us by corporate. Imagine a Superstore with 30 checkout lanes...after Thanksgiving. What is the best impression for customer service? A. Customers walk in and see 30 open lanes with 30 cashiers and only 5 people in each lane, or B. Customers see 30 open lanes, only 1 cashier working, and 150 people waiting in that one lane? This is what you have done to pharmacy.

I have always been in favour of pharmacists providing immunizations. I am on board with MTMs. What I have a problem with is continuing to add tasks to our daily responsibilities while not adding compensation or support for the increased workload. Have you read Animal Farm? You have made us Boxer ("I will work harder"), while you have become the pigs.

Thursday, September 25, 2014

We Just Can't Win

I realise it has only been 9 short months since the changes were made to all Hydrocodone/APAP products that limited them to containing no more than 325mg of Acetaminophen.
I realise doctors can't learn anything new such as drug/strength combinations that have been around for a long time. (This is actually OUR fault. We always call and fix it for them. But I digress...)

Doctor wrote a prescription for Vicodin 5/325. Since we are not allowed to assume which part is correct, we are required to call.
CP: Which did you want? The VICODIN name which is 5/300 or the NORCO which is 5/325?
Dr. I Can't Know New Things: I wanted the 5/300.
CP: Super-dee-duper. Thank you kindly.

As I process it, the insurance rejects as a non-formulary, non-preferred drug. Great.

CP: I need to get this changed to the 5/325.
DICKN'T: Why didn't you tell me that before?
CP: I don't know formularies and copays until I run it. Since I did not, at the time of my initial phone call, have a valid Rx to run to the insurance, I was not privy to that information. Besides, who are you to talk? You didn't even know the correct drug/strength combination you prescribed. After 9 months you should have been able to figure that out by now. Women grow and birth babies in less time than it takes you to learn how to write a prescription...which is your actual job.

Wednesday, September 24, 2014

One Bottle Does Not Equal One Bottle

I know this will seem far-fetched but I got into an argument with a doctor over an error on her e-rx.
If she had only taken my phone call instead of relying on the phone tree to answer my question this would have been an easy fix. Instead I had to resort to telling the secretary who yelled, often incorrectly, to the nurse in the background who yelled to the doctor who yelled back to the nurse, back to the receptionist then into my ear.

Here was the problem: Rx was written for Zyrtec Syrup. Dispense one bottle.
Great. We get this in pints because Medicaid covers it. I'm pretty sure she did not want to give the patient a pint. I asked for clarification on the definition of "one bottle".

Doctor Obvious: I wrote for one bottle. Just give them one bottle.
CP: Bottles come in different sizes. We get pints. This bottle would last for 96 days at your current directions. Is this really what you want?
DO: I want just one bottle.
CP: I can give the patient anywhere from a 1 oz bottle up to a 16 ounce bottle. You have to pick one.
DO: Why are you making this so difficult? Just give one bottle.
CP: Why can't you figure out how to use your e-script software and select a quantity? If you wrote for Hydrochlorothiazide 25mg tablets to dispense "one bottle" would you expect me to just give them my 1000 count stock bottle?
DO: That's different. (actual quote)
CP: HOW? How is that any different?
DO: We've had problems with you before.
CP: Go ahead and say it. I know it's coming...
DO: (and CP, in head) You're the only pharmacist that ever calls on this, blah, blah, blah.
CP: Yep. I guess I like my license. Tell you what. Figure out how to use your software or the next e-rx that comes over like this will just get sent to the Medical and Pharmacy Boards.
DO: 4 ounces! <click>

Yet in everyone's eyes, I was being the asshole. All she had to do was give me a quantity. That would be the same as her writing an Antibiotic Rx for 10ml twice a day, dispense QS without the duration. I would still have to call...and she would probably tell me "one bottle!" without understanding what she did wrong.
It is our job to fix your problems.
It is our job to fix your errors.
It is our job to save your ass.
I'm not asking for a "thank you".
Just don't go all "Vicious Twat" on me.

Tuesday, September 23, 2014

It Says Consultation

Sign, sign, everywhere a sign...do this, don't do that, can't you read the sign?

No. People cannot read them. If they can, they choose not to read them. It is far easier to interrupt someone than to look for something on your own. With that being said, it is quite obvious there is no patience anymore. We are a harried, hurried lot. Protocols and decorum are not meant to be followed.
Lines at businesses are just a suggestion. If you wish to push your way ahead of other people for what you feel is a simple question, then you march your ass right to the front and ask away.

Most pharmacies have designated points, yes, marked with signs, that guide people to:
A. Drop-off,
B. Pick-up,
C. Consultation.

I believe the most common design flaw with this is that the Consultation Window is often too near the pharmacist or another workstation. This invites the Everyday Patient to stroll on up to the window, lean across the counter, and bellow "I just have  a question".
I am certain you do. That is the point of this point of access. Questions. Consultations. However, it does not mean stick your head in my window or sit on my counter and start talking to me as if I am Santa and the counter is my lap. I am on the phone. I am checking prescriptions. If it were your phone call or your prescriptions, would you not want me to be focused solely on you?

It's like walking into a bank, seeing a line of customers, then strolling to the front right next to the first person and saying "I just have a question". That's not how it works.

I think we need to redesign these areas. My first thought is that they need to be on a separate wall of the pharmacy, a wall which a pharmacist will need to move to in order to provide counseling. My second thought is that we should have a glass partition with a speaker. We could set it up like a movie theatre ticket booth or a prison visitation centre. The pharmacist would have to turn on the microphone, or pick up the phone and the patient would talk into the speaker or the phone on his side. Brilliant!


Monday, September 22, 2014

I Was on Hold For...

All professions are not created equal. We each have our own expectations for ourselves and for the other professions with which we deal. Sometimes those expectations are rather unrealistic.

Uber-Tech: Thank you for calling CP's Pharmacy. How may I help you.
Irrational Rx Expectation Deliverer: I need to call in a prescription.
UT: Can you hold, please? CP is on the other line.
IRED: Sure.
(some time later...seconds, minutes, hours, days...)

UT: Thank you for calling...
IRED: I need to speak with the pharmacist. I just called and was left on hold forever.
UT: Apparently it was not forever as here we are. You are rather impatient if you think a few minutes is an eternity. Please hold and I will tell CP you are on the line.

CP: Thank you for holding. This is CP. How may I help you?
IRED: I need to phone in a prescription.
CP: Wunderbar! We love prescriptions.
IRED: I was on hold forever.
CP: And I was busy the whole time. I still am, but, here I am, talking to you. Now what is so important that you needed to call me, hang up, and call back again? It must be life-threatening. Is it Epi-Pens?
IRED: I need to call in Augmentin 875mg bid for 10 days.
CP: Seriously? Augmentin? AND you're calling from an office 45 minutes away? What makes this more important than the other 500 prescriptions I will fill today?
CP: You do know we have voicemail, right? It's the first option available after you select the "doctor's office" option. You called me twice so you should have heard it. Let me ask you a question...When I call your office and ask to speak to the nurse, what happens? I get put through to voicemail. I don't even get the chance to ask my question which is usually about an error on an e-script you sent over. The beauty of voicemail is the convenience of it. YOU get to leave your prescription at YOUR convenience and I get to retrieve it at MY convenience. I also get to rewind and replay it since you give prescriptions like the Micro Machines guy sells cars.
CP: The next time I call your office, I expect my call to be answered immediately by a nurse or the prescriber. I don't care if you're in a room. I don't care if you're drawing blood or giving shots or taking rectal temps with your thumb. If you can't be bothered to wait, or to use voicemail or your e-script software for that matter, while I am counseling a patient, administering shots, performing an MTM, taking prescriptions, retrieving voicemail, checking prescriptions, or any of the other tasks I need to do then you can extend me the same, common courtesy. I will just keep calling, hanging up, and calling back until you answer. Is that acceptable?

Friday, September 19, 2014

Dear Doctor

...I would like to invite you to visit my pharmacy. I would like to take you on a tour. I have been to your office before. I have seen how it is run. I know how long your wait times are. I know how long you spend with patients. I know how your staff treats their patients, and pharmacists who call them. I wish for you to know the same about me.

The main reason I would like you to visit is to show you how we receive prescriptions from your office, and all the other offices in the area.

It was very nice of you yesterday to see a hurried patient.
It was very nice of you to tell her you would encourage us to quickly fill her prescriptions.
The only problem is the method in which you chose to deliver your message: The Notes Section of an E-Script.
That is SO not the way to deliver an important message to the pharmacy.

(For the record, the message read: "Patient is leaving the office now and would like to pick this up in 30 minutes.")

I didn't see it.
When I check my work queue, I don't see messages. I see names. Patient names and drug names.
If you wish to convey a message with a sense of urgency, please choose a more appropriate, expeditious method. I would go so far as to suggest, and this is only a suggestion, that you personally walk to the phone and call in the prescription to me. I know, it seems ludicrous to think that prescribers can use phones and actually call pharmacies but hear me out on this.
Back in the way way back, this is how it used to work. Short of a patient bringing us a handwritten prescription, offices used the telephone to transmit orders. Guess what? That antiquated technology STILL WORKS! All you had to do was call me, add a sense of urgency to the order, and I would have put her among my waiters.

Instead, your order got lost among the other 35 e-scripts that dropped from 4-4:30pm on a busy Thursday and, get this, the patient got mad...AT ME!

From now on, when patients ask me to send refill requests to your office, I am going to have them stand at my counter and watch me. I am going to send their requests via telegraph. I will input every order in Morse Code and tell them their office will be writing them new prescriptions that will be ready at the front desk when they arrive and they should go now.

Refill Request. Stop. Your Patient. Stop. On Way Now. Stop.